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September 9, 2014 -- In rural Kentucky, the most common barrier to regular mammography screening may be a lack of interest on the part of women, according to research presented at the recent American Society of Clinical Oncology (ASCO) Breast Cancer Symposium in San Francisco.

A team from Appalachian Regional Healthcare in Hazard, KY, and the Stanford Cancer Institute found that more than one-third of women who had not had a mammogram said they had no interest in doing so. However, this could be because of a lack of understanding about the exam, said study co-author Dr. Elie Richa.

"It could be that the women say they're not interested because they're not educated about breast cancer screening," he told AuntMinnie.com. "Better education could make these rural women more active participants in their health."

Southeastern Kentucky has multiple barriers to healthcare access, with screening mammography rates of approximately 63%, compared with 80% in urban areas, according to Richa and colleagues.

The group conducted a survey to identify these barriers, using a questionnaire distributed to women 40 years of age and older at local churches and hospitals in 10 counties. Survey questions included age, healthcare coverage, having a primary care physician, and having a mammogram within the past two years. If women hadn't received a mammogram in two years, they were asked why not.

"We wanted to conduct this study because there are a lot of women in Southeastern Kentucky who are not getting regular mammograms, and so we see more women presenting with advanced breast cancer," Richa said.

Not interested

Among the 328 women who participated in the survey, 36.3% had not had a mammogram within the past two years. The median age of survey participants was 57 (range, 50 to 63). Among the 119 women who had not had a mammogram, the most common reason was a lack of interest, at 33%. Other reasons included the following:

Not being referred by their primary physician (24%)

Lack of time (12%)

Lack of insurance (11%)

Old age (5%)

Fear of pain of the procedure (3%)

Lack of knowledge/information (3%)

Lack of transportation (2%)

Seven percent of the women who participated in the survey did not offer a reason for not having had a mammogram.

How can these barriers be ameliorated? There are simple interventions, according to Richa, such as reminder letters from primary care physicians and addressing misconceptions about breast cancer screening -- in particular, whether mammograms cause pain.

"As for women who lack insurance, hopefully Obamacare will allow more of them to get regular breast cancer screening," he said.